Despite sticking to a healthy lifestyle, you may fall ill. Eating healthily, exercising enough, avoiding stress and getting good quality sleep will help your body ward off diseases but don’t come with a 100% guarantee. Other factors out of your control may contribute to a need to take medicines to get better, stay stable or at least take away some of the pain and improve quality of life. New research shows timing might be an important factor in how effective your medicines are. Hence the need for more personalised treatment.
A prescription usually comes with an explanation about how and when to take your medicines. Generally, they will be divided over the day or taken in the morning. That is the case for instance with medication to control high blood pressure. But what is customary isn’t always the best option.
Spanish researchers were wondering whether upon awakening is the most appropriate time to take hypertension medication. They set up the Hygia Chronotherapy Trial with almost 20,000 hypertensive participants. Half of them continued taking their prescribed hypertension medication upon awakening while the other half changed to bedtime to ingest their entire dose.
They were monitored for on average more than six years. The group that took medication at bedtime had about 45% less chance of dying from or suffering heart attack, stroke, heart failure or requiring a procedure to unblock narrowed arteries, compared to the other group that continued taking their medication upon awakening.
Although currently there are no guidelines on preferred treatment time for hypertension, morning ingestion has been the most common. The goal was to reduce morning blood pressure. But the Spanish researchers had already discovered that the average systolic blood pressure when a person is asleep is the most significant to health.
The study results show that people who take their anti-hypertensive medication at bedtime have better-controlled blood pressure and a significantly lower risk of death or illness from heart and blood vessel problems compared with morning treatment. Since it is just as safe to take the pills at bedtime as to take them in the morning, it may be a good idea to switch the time at which to take blood pressure pills, in consultation with your doctor of course. A small change with a big impact!
While medical science advances, it becomes more and more clear there’s a lot of truth in the saying ‘timing is everything’. It has long been known, the human body is governed by circadian rhythm, a natural, internal process that regulates our sleep-wake cycle and repeats roughly every 24 hours. Although circadian rhythm is built-in, it adjusts to local environment by external cues and can also willingly be changed. When you work night shifts, you have to adapt your circadian rhythm. For instance by bright lighting to stay awake at night and by making your bedroom very dark to be able to sleep during the day.
The master clock for circadian rhythm is situated in the brain. But it is now known, many organs and cells in the body function with more or less independent circadian rhythms.
The timing of medical treatment in coordination with these body clocks may significantly increase efficacy of the treatment and thus generate better results. Besides, it may reduce drug toxicity and adverse reactions. Working with circadian rhythms and with the cycle of symptoms that occur in a disease is a line of approach in medical science called chronotherapeutics.
American scientists found out that the biological clock also influences the efficacy of the immune system. Immune cells essential to fight infections and cancers function very differently according to the time of day. Therefore, chemotherapy for people with cancer is more effective when it is administered synchronised to the body’s circadian rhythms.
Diseases such as hypertension, asthma, peptic ulcer, and arthritis also follow the body’s biological rhythms. That’s why it is so important to include these rhythms in drug therapy. The specific time patients take their medication is very important as it has significant impact on treatment success.
Pain medication for women in labour turns out to give longer pain relief when taken by day than by night. Rheumatoid arthritis generates a high level of discomfort in the morning. So it is best to take anti-inflammatory medication such as ibuprofen before bedtime. Peptic ulcer generates the greatest pain at bedtime. Symptoms of asthma occur more often at night. This knowledge should be taken into account when prescribing a schedule for taking medication.
There also seems to be a link between sunlight and the efficacy of medicines, according to Swedish researchers. The body’s ability to break down medicines may be closely related to exposure to sunlight. Depending where you live and what time of year it is, the effect of medicines may vary.
Circadian rhythms are personal and are influenced by an individual’s genetic makeup. Which brings us to the field of personalised medicine. Not only should treatment be adapted to circadian rhythms, but more specifically to your personal body clocks.
The tailoring of treatment to an individual patient dates back to the times of Hippocrates, the father of medicine who lived around 400 BC. Thanks to modern technology and our understanding of the molecular basis of disease, particularly genomics, it has gotten a new impulse.
The idea is that medical decisions, practices, interventions, and products are tailored to the individual patient, based on the patient’s genetic content or other molecular or cellular analysis. Managing a patient’s health should be based on the individual patient’s specific characteristics. Personalised medicine would lead to better diagnosis with earlier intervention and more efficient therapies.
American researchers have taken the first steps towards a personal cancer treatment. People are different -respond differently to different therapies- and tumors are different. The researchers ultimately want to create a virtual twin of a person and his tumor. With help of a computer they want to simulate how those specific tumor cells behave to test millions of possible treatment combinations so as to reach the best combination for a personalised, effective treatment plan.
Dutch researchers went for a more practical option. They have found a way to grow mini-tumors of head and neck cancers in the lab. On these mini-tumors they can test therapies for the patient concerned.
Today, people with the same diagnosis receive standard treatment that is not necessarily effective for everyone. Often physicians use a trial and error strategy until they find the treatment therapy that is most effective for their patient.
Knowing a patient’s genome would make it possible to target medical treatment to fit with these genetic characteristics. There is still an important limitation though. Our understanding of the connection between our genetic material, the disease, and the response to treatment is still incomplete.
Understanding gene interactions is key to personalised medicine. Hopefully in the near future, we will get there so as to develop therapies with the right medicine at the right dose in the right patient.
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